OMB APPROVED NUMBER 0579-0278

United States Department of Agriculture 

Animal and Plant Health Inspection Services 

Veterinary Services

(USDA/APHIS/VS)

Department of Interior 

US Fish and WildlifeService

(DOI/USFWS)

Department of Commerce

National Oceanic and Atmospheric Administration 

National Marine Fisheries Service

(DOC/NOAA-Fisheries)

I. Identification

1. Genus/species (Latin Name): (Common Name):

2. Age (years): Unknown 0-1 >1 Brood

3. Total Net Weight (kg): (if known) Number (X1000): Lot Identification: Number of Containers in Consignment:

II. Place of Origin

1. Country/State: 2. Zone/Compartment:

3.

Aquaculture Establishment (Name and Address and Map Coordinates or GPS if known ):

III. Destination

1. Country/State: 2. Zone/Compartment:

3.

Aquaculture Establishment (Name and Address and Map Coordinates or GPS if known ):

IV. Declarations

Procedures for Aquatic Animal Health Inspections (AFS "Blue Book", current ed.), and which is officially recognized as being free from the pathogens or diseases

listed in the applicable table on the reverse side. 

ONLY ONE ENDORSEMENT IS NEEDED. STAMP APPLICABLE BOX BELOW AND CROSS OUT/INITIAL NON-APPLICABLE BOXES.

USDA/APHIS/VS *

(Farm raised aquatic livestock)

DOI/USFWS

(Freshwater public resource/feral aquatic animals)

DOC/NOAA-Fisheries

(Marine wildlife/feral aquatic animals, and aquatic 

animals in the Exclusive Economic Zone)

Accredited or Federal Veterinarian: Approved Aquatic Animal Inspector: Approved Aquatic Animal Inspector:

Name (print): Name (print) Name (print):

Signature Date Signature: Date: Signature: Date::

Endorsing Area Veterinarian in Charge: Address: Address:

Name (print):

Address:

Federal veterinarian (if applicable) Federal Veterinarian (if applicable)

Name (print) Name (print)

Signature: Date: Signature: Date: Signature: Date:

Stamp of Competent Authority: Stamp of Competent Authority: Stamp of Competent Authority:

VS FORM 17-141

(MAR 2006)

* USDA/APHIS/VS may, on request by DOI or DOC, endorse health certificates for non-farm raised aquatic animals

ANY ADDITIONAL INFORMATION OR SPECIFIC REQUIREMENTS OF IMPORTING COUNTRIES MAY BE ATTACHED TO THIS FORM 

IN AN ADDENDUM

Farmed/Aquaculture Stocks Public resource/Wild/Feral Stocks

Adult Juvenile Larvae Male Gametes Unfertilized eggs Fertilized eggs

HEALTH CERTIFICATE FOR THE EXPORT OF LIVE FINFISH, MOLLUSKS, AND CRUSTACEANS 

(AND THEIR GAMETES) PART 1 OF 2

NOTE: Mark all the relevant items with (X) in theappropriate space. CERTIFICATE NUMBER

The Competent Authority certifies that live aquatic animals or their gametes in the present consignment have as their place of production a Country Zone/Compartment 

Aquaculture establishment that has been subjected to an official health surveillance scheme according to the procedures described in the

OIE Diagnostic Manual for Aquatic Animal Diseases (current ed.), or USFWS/American Fisheries Society-Fish Health Section Standard

The undersigning representatives of the US Competent Authority attest that:

All samples from the present consignment used in determining the health status of the Country Zone/Compartment Aquaculture establishment

were collected and tested in accordance with the procedures described in the OIE Diagnostic Manual for Aquatic Animal Diseases (current ed.), or

 USFWS/American Fisheries Society-Fish Health Section Standard Procedures for Aquatic Animal Health Inspections (AFS "Blue Book", current ed.), with negative results.

USDA to add health certificate number here

*Complete each part of Section 1 with the information specific to this shipment

*Complete country & state

*If the destination country requires facility registration, enter the APHIS Registered Aquaculture 

Export Facility approval number here in addition to the export facility name & address

TEST-AND-SHIP 

If testing of the population to be exported is required (i.e., test 

and ship), complete this declaration: 

- Select “Aquaculture Establishment” certifying negative test 

results for the diseases of concern listed on page 2 of this 

health certificate.

- Select whether the testing performed meets the OIE Aquatic 

Manual OR AFS Blue Book requirements as described therein. 

- Testing should be conducted at an “APHIS-Approved” 

laboratory for OIE listed diseases, and an “Approved” laboratory 

for non OIE listed diseases per the Laboratory Export Testing 

Guidance posted on the IRegs. 

- Testing must be conducted within 60 days of the endorsement 

date (unless otherwise specified by the destination country).

PREMISES FREEDOM 

If premises freedom testing AND facility registration are 

required, complete this declaration:

-Select “Aquaculture Establishment” certifying the 

exporting facility is an approved APHIS Registered 

Aquaculture Export Facility for this destination country AND

is free from the diseases of concern listed on page 2 of this 

health certificate.

-Select whether testing performed meets the OIE Aquatic 

Manual OR AFS Blue Book requirements as described

therein. 

- Testing should be conducted at an “APHIS-Approved” 

laboratory for OIE listed diseases, and an “Approved” 

laboratory for non OIE listed diseases per the Laboratory 

Export Testing Guidance posted on the IRegs. 

*Select if this shipment meets the test-and-ship/ premises freedom criteria*

 (see pg. 3 for scenarios)

*The Category 2 Accredited 

Veterinarian completes

this section

NOTE – the instructions in red should be followed for USDA APHIS endorsement 

*Complete if 

applicable *Country alone is sufficient

*Name and address of the destination required

*The VS Endorsing Official Veterinarian completes this section. 

Endorsement is not limited to the VS AVIC. 

*The stamp should cover the VS Endorsing Official Veterinarian 

signature. 
According to the Paperwork Reduction Act of 1985, no persons are required to respond to a collection of information unless it displays a valid OMB number. Th e time to complete this collection of 

information is estimated to average .5 hours per response, including the time f or reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 

and reviewing the form.

CERTIFICATE NUMBER:

HEALTH CERTIFICATE FOR THE EXPORT OF LIVE FINFISH, MOLLUSKS, AND

CRUSTACEANS (AND THEIR GAMETES) PART 2 OF 2

Freedom from the diseases/pathogens listed below has been 

established for the areas denoted on the right

Country Zone Aquaculture Establishment

Yes No Yes No Yes No

Epizootic hematopoietic necrosis/EHNV

Infectious hematopoietic necrosis/IHNV

Infectious pancreatic necrosis/IPNV

Infectious salmon anemia/ISAV

Oncorhynchus masou virus disease/OMV

Viral hemorrhagic septicemia/VHSV

And any of the following if required by the importing zone

Spring viremia of carp/SVCV

EXPORT OF LIVE MOLLUSKS AND GAMETES

Freedom from the diseases/pathogens listed below has been 

established for the areas denoted on the right

Country Zone Aquaculture Establishment

Yes No Yes No Yes No

Bonamiosis (Bonamia ostreae, B. exitiosa)

Haplosporidiosis (Haplosporidium costale, H. nelsoni)

Marteiliosis (Marteilia refringens, M. sydney)

Mikrocytosis (Mikrocytos mackini, M. roughleyi)

Perkinsosis (Perkinsus marinus, P. olseni)

And any of the following if required by the importing zone

EXPORT OF LIVE CRUSTACEANS AND GAMETES

Freedom from the diseases/pathogens listed below has been 

established for the areas denoted on the right

Country Zone Aquaculture Establishment

Yes No Yes No Yes No

Taura syndrome/TSV

White spot disease/WSSV

Yellowhead disease/YHV

And any of the following if required by the importing zone

VS 17-141

(MAR 2006)

EXPORT OF LIVE FINFISH AND GAMETES

USDA to add health certificate number here

*Check the box to the left if exporting fish or their gametes

*Check the box to the left if exporting mollusks or their gametes

*Check the box to the left if exporting crustaceans or their gametes

Indicate “Yes” to certify the animals 

are susceptible to the disease AND

meet the disease freedom/negative 

requirements selected on page 1 of 

this health certificate. 

Indicate “N/A” under “No” column if 

the animals to be exported are NOT

susceptible to the disease.

Indicate “Yes” to certify the animals 

are susceptible to the disease AND

meet the disease freedom/negative 

requirements selected on page 1 of 

this health certificate. 

Indicate “N/A” under “No” column if 

the animals to be exported are NOT

susceptible to the disease.

Indicate “Yes” to certify the 

animals are susceptible to 

the disease AND meet the 

disease freedom/negative 

requirements selected on 

page 1 of this health 

certificate. 

Indicate “N/A” under “No” 

column if the animals to be 

exported are NOT

susceptible to the disease.

*Only add additional finfish pathogens here 

if it is required by the destination country.

*Only add additional molluscan pathogens here 

if it is required by the destination country.

*Only add additional crustacean pathogens here 

if it is required by the destination country.

**Resources to determine species susceptibility may include: destination country requirements, OIE Aquatic Animal Code/Manual, etc. 

NOTE – the instructions in red should be followed for USDA APHIS endorsement 
Additional scenarios and how to complete this health certificate

• If the facility is registered AND the country allows/ requires export testing via test-and-ship, then

o Enter the APHIS Registered Aquaculture Export Facility approval number under “Section II. 

Place of Origin” > “Aquaculture Establishment.”

o Complete the test-and-ship portion only of “Section IV. Declarations.”

• If no testing is required for the destination country and/or species being exported, then 

o Leave both the test-and-ship and premises freedom portions of “Section IV. Declarations” 

blank.

o If the destination country requires the facility to be registered, then 

 Enter the APHIS Registered Aquaculture Export Facility approval number under 

“Section II. Place of Origin” > “Aquaculture Establishment.”

• If the facility is registered AND the country requires export testing via test-and-ship AND premises 

freedom, then

o Enter the APHIS Registered Aquaculture Export Facility approval number under “Section II. 

Place of Origin” > “Aquaculture Establishment.”

o Complete the test-and-ship portion AND the premises freedom portion of “Section IV. 

Declarations.”